Using a framework to apply the value-based healthcare strategy in a hospital setting: Design, implementation, and evaluation

Value-based healthcare (VBHC) has been widely adopted, but complete implementations remain scarce. Limited practical knowledge limits evaluation of VBHC as a strategy. This study aimed to design, implement, and evaluate a practical framework to support VBHC implementation. Using design science research, five VBHC principles were translated into components and practices, forming the Catharina-VBHC framework. The framework was implemented in a non-academic teaching hospital and its referral network for 20 medical conditions. It established multidisciplinary teams supported by data infrastructure, scientific support, supervision, and structured feedback cycles. Mixed-methods evaluation (surveys, evaluation sessions, and implementation records) showed that the framework has successfully initiated 69 improvement projects, driven by patient-centered goals and enhanced collaboration. Multidisciplinary collaboration and data support were key enablers, while patient participation remained limited and managerial involvement varied. Time constraints hindered sustainability, whereas teams with embedded scientific support, such as PhD candidates or nurse researchers, demonstrated greater progress. Although value-based contracting was considered important, it lagged behind. Overall, the findings demonstrate the feasibility and perceived value of a practical VBHC framework, while underscoring the need for stronger managerial alignment, protected time, and more patient perspective. This study contributes to the emerging literature on how to implement and sustain VBHC beyond academic centers.